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    How Do Surrogates Make Treatment Decisions for Patients with Dementia? An Experimental Survey Study

    Feb 23, 2024
    NATIONAL BUREAU OF ECONOMIC RESEARCH: Despite the growing need for surrogate decision-making for older adults, little is known about how surrogates make decisions and whether advance directives would change decision-making. In a national survey, Lauren Hersch Nicholas, PhD, and co-authors found participants were more likely to indicate that surrogates should choose comfort care when a hospitalized older adult has dementia, even when the patient’s advance directives indicated s/he would prefer life-extending treatments.

    Conversely, for hypothetical patients without dementia, respondents are more likely to state that the surrogate should choose life-extending treatments even when the patient had indicated s/he would want comfort care. Their findings suggest that older adults should choose proxy decision-makers with similar preferences to their own to increase preference-concordant surrogate decisions.
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  • AI image generated by DALL-E

    Are Evidence-Based Medicine and Public Health Incompatible?

    Feb 23, 2024
    UNDARK: Behind many pandemic-era debates are deep divisions between two schools of thought in the world of health care; randomized controlled trials (RCTs) vs. evidence-based medicine (EBM). In environmental health, randomized controlled trials are often impossible. “You’re not going to do a RCT of the effects of PFOA on pregnant women. It’s just not going happen,” said Lisa Bero, PhD, Chief Scientist at CBH. To answer public health questions, the Cochrane folks had to get used to applying their methods to observational studies and other forms of evidence. This specifically meant doing more systematic reviews, in order to have a transparent, consist way of evaluating evidence.
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  • AJPH Feb 2024 cover

    Health Risks of Unaccompanied Immigrant Children in Federal Custody and in US Communities

    Feb 8, 2024
    AMERICAN JOURNAL OF PUBLIC HEALTH: In an essay by Warren Binford of the Center for Bioethics and Humanities & the Kempe Center, Janine Young of the University of California San Diego, Michael Garcia Bochenek of Human Rights Watch and Columbia University, and Jordan Greenbaum of the International Center for Missing and Exploited Children, this team of medical and legal experts provide recommendations to improve the health and well-being of unaccompanied immigrant children who continue to arrive at the US–Mexico border. These children are at high risk for ongoing abuse, neglect, and poor mental and physical health.

    The authors propose that changes be made at public health, medical, and governmental levels to provide early and comprehensive attention to the needs of unaccompanied immigrant children to maximize the likelihood that they will reach their full potential and positively contribute to society.
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  • death in hospital

    Debate simmers over when doctors should declare brain death

    Feb 11, 2024
    NATIONAL PUBLIC RADIO: Benjamin Franklin famously wrote: "In this world nothing can be said to be certain, except death and taxes." While that may still be true, there's a controversy simmering today about one of the ways doctors declare people to be dead. The debate is focused on the Uniform Determination of Death Act, a law that was adopted by most states in the 1980s. The law says that death can be declared if someone has experienced "irreversible cessation of all functions of the entire brain." But some parts of the brain can continue to function in people who have been declared brain dead, prompting calls to revise the statute.

    Matthew Decamp, MD, PhD, co-authored a recent position paper for the American College of Physicians, with the intent of fostering honesty, transparency, respect, and integrity in how death is determined and communicated to patients and families. Physicians can ensure trust by communicating determinations of death that are consistent with medical ethics, the law, and the best available scientific evidence.
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  • mRNA

    CU Bioethics part of team exploring new treatments for metabolic disease

    Feb 12, 2024
    SOM DEAN'S NEWSLETTER: A team of MIT researchers will lead a $65.67 million effort, awarded by the U.S. Advanced Research Projects Agency for Health (ARPA-H) to develop ingestible devices that may one day be used to treat diabetes, obesity, and other conditions through oral delivery of mRNA. Matthew Wynia, MD, MPH and Eric Campbell, PhD along with colleagues at the Center for Bioethics and Humanities, will focus on exploring the ethical dimensions and public perceptions of these types of biomedical interventions.
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  • Interim Harvard Pres Alan Garber

    Interim Harvard President Garber to Remain on Pharma Company Board

    Jan 30, 2024
    THE HARVARD CRIMSON: Interim Harvard President Alan M. Garber ’76 will remain on the board of one pharmaceutical company while leading the University, a decision that complicates his relationship with the Harvard Management Company and raises questions about potential conflicts of interests.

    "A conflict of interest isn’t just about money. Money is a big part of it, but it's also about power and decision-making capability,” said Lisa Bero, PhD. “Even if someone’s on a board that they’re not paid for, sometimes people think that’s okay, but they’re still in a position of power. “They can make decisions that would affect them or interests close to them just by serving on the board,” Bero added.
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  • Dana Farber exterior

    How does bad data slip through? Allegations of research fraud raise questions about ‘peer review.’

    Jan 28, 2024
    BOSTON GLOBE: When a blogger posted allegations that researchers at the Dana-Farber Cancer Institute had manipulated data in published studies, the reports were shocking — and yet also familiar. Such cases are appearing with growing frequency, raising concerns about the integrity of scientific research and how carefully papers are vetted at even prestigious journals. The matter is still under investigation, although the hospital is moving to retract six papers and correct 31.

    How does bad data slip through? Lisa Bero, Ph, Chief Scientist at CBH explains, "The volume of requests for peer review is just way, way too high. And reviewers’ work varies widely from very cursory to very thorough. The directions they receive are often vague, and rarely include scrutinizing the data." Instead of having more peer reviewers, Bero recommends having reviewers who specialize in certain aspects of research.
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  • Male senior citizen in hospital gown looking out window

    U.S. health care isn’t ready for a surge of seniors with disabilities

    Jan 14, 2024
    WASHINGTON POST: Lisa Iezzoni, MD, MSc, a professor at Harvard Medical School who has lived with multiple sclerosis since her early 20s says, “For too long, medical providers have failed to address change in society, changes in technology and changes in the kind of assistance that people need.” Among Iezzoni’s notable findings in recent years, are that most doctors are biased.

    In a survey published in Health Affairs, 82 percent of physicians admitted they believed people with significant disabilities have a worse quality of life than those without impairments. Only 57 percent said they welcomed disabled patients. “It’s shocking that so many physicians say they don’t want to care for these patients,” said survey co-author, Eric Campbell, PhD.
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  • JCoQPS Dec 23 cover

    Documentation of Disability Status and Accommodation Needs in the Electronic Health Record: A Qualitative Study of Health Care Organizations’ Current Practice

    Jan 2, 2024
    JOINT COMMISSION ON QUALITY & PATIENT SAFETY: Individuals with disabilities are one of the largest and most underserved subpopulatioMegan A. Morris, PhD, MPH, CCC-SLP and co-authors interviewed health care organizations (HCOs) and found the main purpose for collection of disability status and accommodation needs in the EHR was to prepare for patients with disabilities.

    Participants believed collection should (1) occur prior to patients’ clinical encounters, (2) be conducted regularly, (3) use standardized language, and (4) be available in a highly visible location in the EHR. The authors believe routine collection of this information along with leadership support, will enhance HCOs’ ability to understand the needs of their patients and enhance their ability to proactively provide accommodations to ensure equitable access to health care services.
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  • NYT illustration by Tim Pearce

    We’re Thinking About Pain All Wrong

    Dec 24, 2023
    NEW YORK TIMES: Why do we attempt to rationalize pain as a deserved punishment or a fit of hyperbolized acting by the weak or lazy? Daniel Goldberg, JD, PhD, says an important aspect is fear. We don’t want to believe we could be stuck in unremittable agony, so we look for differences in those who are afflicted and point to those traits as reasons for their suffering.
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  • Illustration: spinal cord stimulator

    Corporate Influences on Science and Health—the Case of Spinal Cord Stimulation

    Dec 18, 2023
    JAMA VIEWPOINT: Adrian C. Traeger, PhD, School of Public Health at University of Sydney and Lisa Bero, PhD, at the Center for Bioethics and Humanities found that over the past 3 years, several independent studies have questioned the safety and efficacy of spinal cord stimulation to manage pain.

    The spinal cord stimulator industry was swift to respond by creating counterevidence (original studies and reviews), supporting researchers to write criticisms in industry-sponsored journals. These tactics have historically extended into the tobacco industry, pharmaceutical, lead, vinyl chloride, and silicosis-generating industries, to protect profits.

    Bero and Traeger conclude that to maintain independence, professional organizations and publications should not accept industry funding and should have strict policies to actively manage financial conflicts of their members.
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  • Health Affairs Dec 2023 cover

    Why Dropping Most COVID-19 Vaccine Mandates Is Now Ethical

    Dec 7, 2023
    HEALTH AFFAIRS: The American Board of Bioethics Program Directors (APBD) approved a new position this fall, that universal COVID-19 vaccine mandates are not presently ethically supportable. Matthew Wynia, MD, MPH, and colleagues state that the values and principles that guided their earlier position remain the same, but the context has evolved.

    Today, although the benefits of updated vaccination to individuals remain considerable, the relative value of universal vaccination against COVID-19 for achieving safety for others seems considerably lower than it was in fall 2021. This is why the APBD now supports policy decisions to lift most COVID-19 vaccine mandates but continues to call for freely available access to updated vaccines against COVID-19. They also recognize that vaccine mandates could again become ethically justifiable should circumstances change.
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  • Walking tightrope with heart and mind

    Spheres of Morality: Is There a Point?

    Nov 27, 2023
    AMERICAN JOURNAL OF BIOETHICS: When and how are physicians obligated to patients, colleagues and the community? Drs. Matthew Wynia and Brian Jackson examine 125 years of thought on physician ethics. and how the new concept of "spheres" might help physicians better understand the reasons they feel conflicted in some cases, and become better equipped to negotiate their roles in an increasingly complex and interconnected healthcare system.
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  • Cannabis oil and plants

    New Interactive Evidence Based Mapping Tool Gives Policymakers More Insight into Highly Concentrated Cannabis Products

    Nov 8, 2023
    CU ANSCHUTZ NEWS: After conducting the first scoping review of its kind, AMC researchers Lisa Bero, PhD, Rosa Lawrence, BA, Jon Samet, MD, MS, and colleagues developed an evidence based interactive mapping tool that can be used to find the studies that have been done on high concentration cannabis products, to assist lawmakers as they consider regulating the concentration of THC in cannabis products and as more potent products move into the marketplace.

    This State of Colorado funded scoping review was published in the American Journal of Public Health. “During the review we discovered that research on cannabis is out of sync with the higher concentrations found in today’s products. While many of these studies need to be expanded to keep up with current trends, it opens up a conversation that could lead to broader research and collaboration between medical experts and state governments as well as close the knowledge gaps about these products,” says Professor Bero.
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  • WHO illustration of health as human-right

    Health as a Human Right: A Position Paper From the American College of Physicians

    Oct 31, 2023
    ANNALS OF INTERNAL MEDICINE: Authors Matthew DeCamp, MD, PhD, and Lois Snyder Sulmasy, JD, recognize health as a human right based in the intrinsic dignity and equality of all patients and supporting the patient–physician relationship and health systems that promote equitable access to appropriate health care. They propose the U.S. should move closer to respecting, protecting, and fulfilling for all the opportunity for health.

    The ACP Ethics Manual states, “The principle of distributive justice requires that we seek to equitably distribute the life-enhancing opportunities afforded by health care. How to accomplish this distribution is the focus of intense debate.”
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  • Pt at opthalmascope with physician

    How Artificial Intelligence is Changing Health Care

    Oct 25, 2023
    CU ANSCHUTZ NEWS: As articifical intelligence (AI) technology evolves, ethical questions and challenges arise. CBH faculty Matthew DeCamp, MD, PhD, asks, ‘Who are we forgetting? Who is left out by these tools?’ There’s a place in ethics that puts special emphasis on the way we treat those who are or who may be in the minority and are harmed by what we’re doing,” he says. “It’s important to not assume that just because something is better overall it’s better for everyone. There may still be individuals and groups who are harmed by the technology.”

    Addressing those challenges should come in the design process of new AI tools. “We need to start demanding that AI proactively reduce disparities and equities, not design it and wait for that to happen later,” DeCamp says.
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  • NYT illustration by Evan Cohen

    How Aid in Dying Became Medical, Not Moral

    Oct 24, 2023
    NEW YORK TIMES: The debate over aid in dying still rages in the language that medicine and the media use to describe the practice. “There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway,” said Dr. Matthew Wynia, Director of the Center for Bioethics and Humanites.
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  • JAMA logo w photo of residents and industry reps

    Next Steps for Addressing Conflicts of Interest in Residency Programs

    Oct 16, 2023
    JAMA NETWORK OPEN: In an invited commentary, Matthew K. Wynia, MD, MPH, Christine M. Baugh, PhD, MPH, and Eric G. Campbell, PhD, note that academic settings are where physicians-in-training establish their habits and form lifelong professional identities, and interventions to reduce or eliminate gifts from medical and device companies to trainees have long been known to have durable effects. The authors suggest that academic institutions should be exemplars of avoiding COI, by prohibiting gifts from medical and device makers.
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  • Lee Gelernt

    Lee Gelernt from the ACLU Recounts Fight to Keep Migrant Families Together

    Oct 3, 2023
    CU ANSCHUTZ NEWS: ‘It’s almost impossible to fully describe the harm,’ lawyer says during his keynote address at the Advocating for Children in Migration symposium on September 21st.

    It all started with the asylum-seeking mother who escaped violence in the Democratic Republic of Congo in 2018, arriving barefoot and hungry at the border. By the time Lee Gelernt, JD, arrived in San Diego to represent the woman placed in a makeshift detention center, her 6-year-old daughter had been taken from her, shipped off to Chicago four months earlier.

    Gelernt, a lawyer with the American Civil Liberties Union (ACLU), promptly filed a lawsuit for her return and began collecting numerous heart-wrenching stories from other affected families. That kicked off his successful class-action lawsuit against the Trump administration’s policy of separating immigrant families at the U.S.-Mexico border.

    “There are still some people who think that policy should be reenacted. “The family separation lawsuit is a good lens through which to look at how we try and shape the narrative and how we reach the public: what works, what doesn't work and what are the real challenges.”
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  • newborn foot and adult hand

    Prenatally-diagnosed renal failure: an ethical framework for decision-making

    Sep 26, 2023
    JOURNAL OF PERINATOLOGY-NATURE: Jackie Glover, PhD and colleagues in the Pediatrics Department at Children's Hospital Colorado, developed an ethical framework to guide patient care and research for prenatally diagnosed severe renal anomalies. The authors identifiy ethical challenges in communication, timing of decisions and scarce resources.

    The framework addresses shared decision-making, establishing trust, managing disagreements, the child’s best interests, the harm principle, and a zone of parental discretion. Glover and co-authors believe that operationalization of this framework affords the support needed to provide comprehensive patient and family-centered care for these complex patients. Read article>>
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